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• Assists with medical record documentation requests and leverages medical management system to initiate case and/or authorization to support clinical processes.
• Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes.
• Actively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership.

Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote it one of the “Best Places to Work in PA”.

• Provides support in the functional areas of the Revenue Cycle, including Billing, Reimbursement, and Insurance Recovery.
• Ensures adherence to company policies, procedures, and related government regulations.
• Prepares and submits claims to various insurance companies electronically or on paper.

At St. Luke’s, we pride ourselves on fostering a workplace culture that values diversity, promotes collaboration, and prioritizes employee well-being.

• Assist clients in the initiation of auto insurance claims, providing guidance and support through the initial reporting process.
• Follow up with insurance companies to check on status of claims and troubleshoot any hold ups / blockers in their processing.
• Gather and review all necessary documentation related to insurance claims, including accident reports, policy details, and other relevant information.

Lendbuzz develops innovative technologies that provide underserved and overlooked borrowers with better access to credit.

• Deliver comprehensive care navigation and access support for Sana members, ensuring they receive the right care at the right time, place, and cost.
• Collaborate with cross-functional teams, including our virtual care practice and customer support, to provide seamless care navigation services.
• Educate members on their care referral options, empowering them to make informed healthcare decisions.

Sana Benefits is building affordable health plans designed around Sana Care, their integrated care model connecting members with unlimited primary care and expert care navigation at no additional cost to them. They've compiled an innovative team with top talent from across the healthcare and technology industries to deliver engaging, modern, concierge-style healthcare for their members.

• Act as the first point of contact to customers who are reporting an insurance claim.
• Gather and record all relevant information regarding the insurance claim and enter data into system.
• Provide ad-hoc administrative support to the claims department.

As Canada’s most cutting-edge home insurance carrier, Max Insurance is entering a period of exciting growth.

• Manages client denials and concerns through analytic review of clinical documentation.
• Delivers final determination based on skillsets and partnerships with Humana parties.
• Investigates and resolves member and practitioner issues via phone or face to face to support quality goals.

Humana Inc. is committed to putting health first for teammates, customers, and the company. Through Humana insurance services and CenterWell healthcare services, they strive to make it easier for millions to achieve their best health, delivering needed care and service.

• Perform auditing of claims, ensuring processing, payment, and financial accuracy.
• Complete reporting of audits finalized with decision methodology for procedural and monetary errors.
• Communicate corrections and adjustments to Examiners as identified on pre-payment audits.

Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their bills.

• Oversee the end-to-end billing process.
• Maintain comprehensive billing records, monitor and report key performance indicators related to claims submission, denial resolution, and payment posting.
• Serve as the primary point of contact for internal teams and external payers.

Apollo Behavior is the premier provider of ABA therapy in metro Atlanta, and the largest ABA provider based in Georgia.

Acts as key point of contact for the processing of enrollment applications for all providers. Works with System Credentialing and local medical staff contacts. Responsible for completing the ongoing review and attestation of all Munson Healthcare provider enrollment records.

Munson Healthcare is northern Michigan’s largest healthcare system, with eight award-winning community hospitals serving over half a million residents.

Perform pre-call analysis and check the status by calling the payer or using IVR or web portal services. Maintain adequate documentation on the client software to send the necessary documentation to insurance companies. Comply with all reimbursement and billing procedures for regulatory, third party, and insurance compliance norms.

You’ll help connect providers, patients and communities with innovative solutions that create real value by supporting both the financial and clinical sides.

• Support patients through the denial and appeal process.
• Coordinate with healthcare providers and insurance companies.
• Ensure seamless access to our innovative DME device.

Noctrix Health is redefining the treatment of chronic neurological disorders with clinically validated therapeutic wearables. Their team is dedicated to delivering prescription-grade therapy with an outstanding user experience and has pioneered the world’s first drug-free wearable therapy.

• Process transactions on insurance accounts and interact with insurance companies.
• Communicate with staff and third-party customers to ensure accurate processing.
• Prioritize accounts to maximize aged AR resolution, and research documentation.

Oregon Health & Science University values a diverse and culturally competent workforce. They are proud of their commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status.

• Ensuring providers are credentialed in a timely manner by monitoring the submission process.
• Monitoring submission processes, updating protocols, and managing Virtual Assistants/BPO.
• Communicating with payors and conducting regular reviews to validate internal credentialing data.

Grow Therapy aims to be the trusted partner for therapists growing their practice, and patients accessing high-quality care. They are a three-sided marketplace that empowers providers, augments insurance payors, and serves patients and have empowered more than ten thousand therapists.

• Multi-task position covering main functions of the Central Business Office.
• Accurately handle at least one unit function of the Central Business Office.
• Monitor billing errors and claim/line item rejections.

Piedmont Healthcare is a company in the healthcare sector, though further details are not given in the job description.

• Responsible for collections and appeals from various Federal, State, & Third Party (HMO, PPO, IPA, TPA Indemnity) payers.
• Optimize payment reimbursements by reviewing accounts for billing accuracy and health plan coverage.
• Process an appeal, resubmit/rebill, or forward claims for adjudication as necessary.

BillionToOne is a next-generation molecular diagnostics company on a mission to make powerful, accurate diagnostic tests accessible to everyone. Forbes recently named them one of America's Best Startup Employers for 2025, and they were awarded Great Place to Work certification in 2024.

In this position, you will be responsible for handling a variety of tasks to ensure payment collection activity is resolved, disputed, or sent to Legal. Conduct collection activity on appealed claims by contacting government agencies, third party payers via phone, email, or online. Communicate with insurance plans and researching health plans for benefits and types of coverage.

Sutherland is a digital transformation company helping customers globally achieve greater agility and transform automated customer experiences for over 35 years.

The Insurance Reimbursement Specialist maximizes reimbursement by collecting outstanding balances from insurance companies. The Specialist follows up on unresolved claims and escalates claims for reconsiderations. The Specialist works with CareDx Payer Dispute Resolution/Market Access teams ensuring proper reimbursement from payers.

CareDx, Inc. is focused on the discovery, development, and commercialization of clinically differentiated, high-value healthcare solutions for transplant patients.

The Provider Enrollment Specialist is responsible for timely and effectively enrolling practitioners in health plans. The Specialist will monitor progress, ensure timeliness of enrollment completion, and provide updates. The Specialist will maintain accurate provider profiles in IntelliCred and CAQH.

Pediatrix Medical Group is one of the nation’s leading providers of specialized health care for women, babies and children since 1979.

• Processes acute and post-acute inpatient medical or behavioral health and select intensive outpatient higher level of care requests through review of the submitted request and applicable clinical records
• Collaborates with UM department staff, including Clinical Support Specialists and Medical Directors to make a final determination, and with Care Management staff on discharge planning and transition of care activities.
• Identifies and refers members with complex needs to the appropriate population health and/or care management program.

Capital Blue Cross promises to go the extra mile for our team and our community. Our employees consistently vote us one of the “Best Places to Work in PA, and we foster a flexible environment where your health and wellbeing are prioritized.

• Responsible for accurate and timely processing of designated claims.
• Resolve claim issues, answer incoming SalesForce cases and management of issues that escalate to the RCM team.
• Management of accounts receivable, including analysis of aged AR, and investigating denial sources.

Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems.